317.924.3228
317.924.3228
317.924.3228
  • Indianapolis, IN - 6335 Intech Commons Drive 46278
  • Avon, IN - 8102 Kingston St 46123
  • 317.924.3228 | Indianapolis, IN - 6335 Intech Commons Drive
  • 317.396.1873 | Avon, IN - 8102 Kingston St
Indianapolis Endodontics, PC
Root Canal Specialist Recognized By
The American Dental Association

  • Welcome
  • Our Practice
  • Meet the Doctors
    • Dr. William R. Adams
    • Dr. David H. Pfotenhauer
    • Dr. Paul J. Ley
    • Dr. Ashleigh M. Rexford
    • Dr. Joseph B. Adams
    • Dr. Nomin Aomin
  • Meet the Team
  • Procedures
    • Dental Emergencies
    • Prevention
      • Dental X-Rays
      • Digital X-Rays
      • 3D Imaging (Kodak/Carestream)
      • Panoramic X-rays
      • Root Canal Therapy
    • Endodontics
      • Gentle Wave Procedure
      • Cracked Tooth
      • Root Amputation
      • Root Canal Retreatment
    • Limited Oral Surgery
      • Antibiotic Treatment
      • Apicoectomy
      • Bone Grafting
      • Oral Pathology
      • Platelet Rich Plasma (PRP)
    • Dental Anxiety and Fear
    • Dental Videos
    • Office-Based Anesthesia
  • Contact Us
    • Policies & FAQs
    • Links
  • Patient Forms and Referrals
    • Appointment Request
  • Patient Reviews
  • Online Payments
  • Carecredit
  • Appointment Request

Patient Forms and Referrals

If you are a new patient to our office, the attached file contains our new patient forms that will need to be filled out when you arrive at our office. Printing them, filling them out and bringing them with you will allow us to attend to your dental needs more quickly than completing them on your arrival.  Thank you and please call our office if you have any questions at all.

Insurance Agreement

Patient Information

Medical & Personal History

Optional OCR Notice of Nondiscrimination

Acknowledgement of Receipt of HIPPA

Endo Referral for Providers

CBCT and/or PANO Referral for Providers

 

This web site uses files in Adobe Acrobat Portable Document Format (pdf) which require Adobe® Acrobat® Reader for viewing and printing. It is available to download free.

 

Contact Us.

We encourage you to contact us with any questions or comments you may have. Please call our office or use the quick contact form.

Contact Us

We encourage you to contact us with any questions or comments you may have. Please call our office or use the quick contact form below.

Testimonials.

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